Fractions of total plasma homocysteine in patients with ischemic stroke before the age of 55 years.

The mechanism responsible for the association between elevated circulating homocysteine levels and ischemic stroke remains unclear. Therefore, the authors assessed total plasma homocysteine (tHcy) and its fractions (free [fHcy] and protein-bound [bHcy] homocysteine) in patients with ischemic stroke before the age of 55 years. Fifty patients (23 men, mean age 46.8+/-7.6 years) with ischemic stroke or transient ischemic attacks, with symptoms lasting < 72 hours were enrolled. In this group: 32 (64%) patients had hypertension; 12 (24%), ischemic heart disease (IHD); and 20 (40%), type 2 diabetes mellitus (DM). The control group consisted of 30 matched healthy individuals (17 men, mean age 44.6+/-6.2 years). The tHcy, fHcy, and bHcy levels were determined by high-performance liquid chromatography. tHcy and its fractions did not differ significantly between patients and controls. However, stroke patients with hypertension had significantly higher concentrations of tHcy and bHcy compared to stroke patients without hypertension (tHcy 13.0+/-3.3 vs 10.7 +/-3.2 micromol/L, p < 0.05; bHcy 9.7+/-2.6 vs 7.8+/-2.3 micromol/L, p < 0.01, respectively); fHcy was borderline significant: 3.1 (1.5-6.5) vs 2.5 (1.8-5.3) micromol/L, p = 0.05. The presence of IHD, DM, hyperlipoproteinemia, clinical subtypes of stroke, smoking, and family history of stroke did not influence these parameters. In the group of 50 patients, tHcy correlated with mean systolic blood pressure (BP) (r = 0.3, p < 0.05) and bHcy correlated with mean systolic and mean diastolic BP (r = 0.3, p < 0.05). These findings suggest an association between hypertension and redox status of Hcy in patients with ischemic stroke before the age of 55 years. This observation supports the hypothesis that elevated BP may contribute to Hcy-related vascular injury.